Changeover from peridural to transdermal opiate analgesia in abdominal tumor pain syndrome.

In a 32 years old patient with advanced gastric cancer epidural analgesia with local anaesthetic and morphine via a thoracic epidural catheter was required because of intractable pain and intolerable side effects of intravenous morphine. In spite of good efficacy it was decided to remove the catheter because of technical problems and the risk of infection during chemotherapy. Analgesic therapy proceeded to non-invasive transdermal fentanyl, using an intravenous fentanyl pea-pump during transition. The equipotent daily dose ratio of epidural morphine to transdermal fentanyl was calculated as 2.25:1.